Ghana Handbook Global Health Fellows Program Updated: 3/27/2015

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Table of Contents NPGH CONSORTIUM IN GHANA ...... 3 Consortium Universities ...... 3 Partner Institutions ...... 3 Research Opportunities ...... 4

Country Overview ...... 6 Health Statistics ...... 6 Health & Healthcare ...... 6 PREPARING FOR YOUR TRIP ...... 7 Financial ...... 7 Entry/Exit Requirements ...... 7 Visa ...... 7 Vaccines and Travel-related Health Concerns ...... 7 Other Documentation ...... 8 Traveler Security Registration & Emergency Contacts ...... 8 Emergency Contacts ...... 8 Smart Traveler Enrollment Program (STEP) ...... 8 Packing for your Trip ...... 8 IN-COUNTRY ...... 11 Communication ...... 11 Money ...... 11 Transportation & Traveling ...... 12 Entertainment ...... 12 Food ...... 13 Health & Safety ...... 13 Housing ...... 14 Local Customs ...... 14 REFERENCES & RESOURCES ...... 15

Page 2 NPGH CONSORTIUM IN GHANA

Consortium Universities . University of Michigan . University of Washington

Partner Institutions . Kwame Nkrumah University of . University of Cape Coast Science and Technology (KNUST) . University of Development . University of Ghana Studies . Ministry of Health / Ghana Health Service

Kwame Nkrumah University of Science and Technology (KNUST): KNUST was established in 1952. The College of Health Sciences includes the Faculties of Allied Health Sciences, Pharmacy and Pharmaceutical Sciences, School of Medical Sciences, Dental School, School of Veterinary Medicine, and the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR). The School of Medical Sciences was founded in 1975 with an original mandate to train physicians, medical scientists and medical laboratory technologists. Currently, the School has 14 departments teaching courses, and concentrates on training physicians at the undergraduate level and medical scientists at the postgraduate levels. The Medical Laboratory Technology program is run separately in the Faculties of Allied Health Sciences.

University of Ghana: The University of Ghana was founded in 1948 as the University College of the Gold Coast and is the oldest and largest of six public Universities in Ghana. The current student population is 29,754, with 1,816 post-graduate students, 26,154 Bachelor’s degree students, and 1,784 sub-degree students. There are 865 faculty members engaged in research and teaching. The College of Health Sciences as well as the Schools of Medicine, Dentistry, and Allied Health Sciences are located at the Korle-Bu Teaching Hospital.

University of Cape Coast: The University of Cape Coast was founded in 1971, and has a total student population of over 35,922: 14,815 Regular Undergraduate Students, 2,146 Sandwich Students and 18,018 Distant Learning Students. The School of Medical Sciences at the University of Cape Coast (UCC) was established in response to the deficit

Page 3 of health care workers, especially doctors. UCC's goal is to train enough doctors to supplement the number of doctors trained at the other three medical schools in Ghana. The curriculum at UCC focuses on clinical and community experiences; the goal of this community based approach is to identify the common causes of morbidity and mortality in rural Ghana. Through UCC's novel curriculum students learn early on in their training about the science & care of patients. Graduates from UCC will understand the social, cultural, environmental and other factors that impact the health of their patients.

University of Development Studies: The University for Development Studies (UDS) was established in May 1992 in Tamale to blend the academic world with that of the community for the development of Northern Ghana and Ghana as a whole. It began academic work in September 1993 with the first batch of 39 students admitted into the Faculty of Agriculture (FOA), Nyankpala. The University's principal objective is to address and find solutions to the environmental problems and socio-economic deprivations that have characterized northern Ghana in particular and are also found in some rural areas throughout the rest of the country. The University operates four satellite campuses spread out in the three Northern Regions of Ghana: Wa Campus (Upper West Region), Navrongo Campus (Upper East Region), and Tamale and Nyankpala Campuses (Northern Region). The School of Medicine at the University of Development Studies was founded in Tamale in 1996 and is located on the Tamale Campus. Previously, medical students received basic science training at UDS and then completed their clinical training at University of Ghana Medical School (UGMS). However due to limited space and resources at UGMS, UDS began offering clinical training at their Tamale campus.

Research Opportunities The University of Michigan and the University of Washington have strong research collaborations with several institutions in Ghana dating to 1985 (UM) and 1993 (UW). The University of Ghana (UG), KNUST, UCC, UDS, and the research unit of the Ghana Health Service have partnered with UM on seven active research studies (including four NIH-funded studies and one Fogarty Institute training grant for post-doctoral research fellows), and have published 45 peer-reviewed publications with Ghanaian co-authors. Areas of research include maternal and child health, emergency medicine, human resources for health, and educational assessment. UM also participates in longstanding medical student educational collaborations with UG, KNUST, UCC and UDS. Over the past five years, UM hosted approximately 93 Ghanaian medical students, and has sent approximately 40 UM students to Ghana.

The UW-KNUST collaboration is funded by a Fogarty D43 award to strengthen the capacity for injury control research in Ghana, build a cadre of qualified researchers, and generate research that will be translated into effective activities and implementable policy across the spectrum of injury control. This program builds upon a 15-year collaboration for injury research between KNUST and UW, and has significantly influenced policy in Ghana. The collaborative research in Ghana incorporates

Page 4 community-based surveys that include direct household visits and interviews. This research has been instrumental in developing and implementing low-tech and sustainable programs to establish or improve pre-hospital trauma care in Ghana.

Page 5 COUNTRY OVERVIEW

Health Statistics Total population: 23,837,000 Gross national income per capita (PPP international $): 1,320 Life expectancy at birth m/f (years): 57/64 Probability of dying under five (per 1 000 live births): 69 Probability of dying between 15 and 60 years m/f (per 1 000 population): 402/253 Total expenditure on health per capita (Intl $, 2009): 122 Total expenditure on health as % of GDP (2009): 8.1

Healthcare Most health care is provided by the government and largely administered by the Ministry of Health and Ghana Health Services. The healthcare system has five levels of providers: health posts (which are first-level primary care for rural areas), health centers

Page 6 and clinics, district hospitals, regional hospitals, and tertiary hospitals. These programs are funded by the government of Ghana, financial credits, Internally Generated Fund (IGF), and Donors-pooled Health Fund. Hospitals and clinics run by religious groups also play an important role. There are 172 hospitals in Ghana. Hospitals run by religious groups make up 35% of Ghana's health service provision. Collectively, they are known as the Christian Health Association of Ghana. Some for-profit clinics exist, but they provide less than 2% of health services.

PREPARING FOR YOUR TRIP

Financial Please notify your credit card and banking institutions that you will be abroad for 11 months to prevent problems accessing funds while you are abroad.

Entry/Exit Requirements Visa A passport and a visa are required, as is evidence of a yellow fever vaccination. Travelers should obtain the latest information and details from the Embassy of Ghana: http://www.ghanaembassy.org/

Individuals who will be staying in Ghana for more than 60 days will have to obtain a visa extension once they are in country and pay an additional US$10 for every extra 30 days, regardless of the type of visa they obtain (single-entry versus multiple entry). This should be a fairly straightforward process requiring photocopies of your passport and Ghanaian visa, as well as a few additional passport photos (all easily obtainable in big cities)…plus some patience, as the government officials will likely make you wait in their office for no apparent reason. If you obtain the visa extension in Accra, it can take as many as two weeks to process. However, at any other regional capital (Kumasi included), it usually shouldn’t take more than 48 hours.

Ghanaian officials may or may not get suspicious if you keep extending a tourist visa month after month; letters of support from the local institutions you work with should take care of any problems. Previous trainees have also had to purchase “emergency visas” for $100 when re-entering the country, even with a multi-entry visa. In truth, making friends at the embassy or with government officials is probably the best way to ensure minimal hassle with visas.

Vaccines and Travel-related Health Concerns Check the CDC’s web page for up-to-date information on recommended vaccines for traveling to Ghana: http://wwwnc.cdc.gov/travel/destinations/traveler/none/ghana

Page 7 Other Documentation Whenever traveling, it is important for you to be prepared in case your passport and other important documents are lost or stolen. Therefore, we recommend that all travelers have a Xerox copy of their important documents as well as an electronic copy. You may also email or mail a copy of these documents to the Support Center ([email protected]) for safe keeping in your personnel file.

Traveler Security Registration & Emergency Contacts Emergency Contacts All trainees should provide emergency contact information to the Support Center at the start of their training experience. This information will be kept private but is important to have on file in case of an emergency that requires our assistance.

Smart Traveler Enrollment Program (STEP) Sign up for the State Department’s free Smart Traveler Enrollment Program (formerly known as “Travel Registration” or “Registration with Embassies”) to receive the latest travel updates and information. When you sign up, you will automatically receive the most current information they compile about the country where you will be traveling or living. You will also receive updates, including Travel Warnings and Travel Alerts (where appropriate). Register on the STEP website: http://travel.state.gov/travel/tips/registration/registration_4789.html

Packing for your Trip General Supplies . Current converter. Ghana runs on 220/240 volts, while North America runs on 110/120 volts. Check the labels on your electronics to see if you’ll need a converter. . Plug adapters: Ghana has British and Indian outlets, so you will need an adapter to plug in American devices. These are readily available in the markets, as are extension cords and surge protectors, though the latter are of variable quality. . Surge protector: Plug your electronics into a surge protector whenever possible to extend their life—power fluctuations are very rough on batteries. . Toiletries such as toothpaste are available in country. Shampoo & conditioner and other hair products of quality similar to that in the U.S. are generally very hard to come by. Contact lens solution has also been notoriously difficult to come by. It is recommended that you bring your own. . Camping supplies (small tent, mat, sleeping bag) if you plan on doing any trekking, though certainly not necessary as most of the major tourist sites will have guest houses and hotel accommodations available. . Day pack for short trips

Page 8 . Small pillow and at least one set of sheets and one pillow case: these are often not provided at guest houses or in the clinical student hostel, and it can be difficult to find sheets of good quality in stores like Melcom. . Small tokens from your hometown/home institution to give out as gifts . Laptop for work and to connect with friends and family back home o Don’t bring iPhones or iPads unless you plan to use them without internet. Wifi is not readily available, and if it is, it may be very slow. . External hard drive with movies and TV shows . Bring your own electronics—they are very expensive in Ghana and often of questionable quality . Small flash light (there are no street lights or sidewalks in many places and you will want drivers to see you!). Also, this is highly recommended given frequent power outages. . A headlamp is also useful so that you can have both hands free while working . Research supplies: you can find stationary/pens/office supplies fairly readily on the street as well as in superstores like Melcom, so perhaps bring a few items that you enjoy using and leave the rest at home. . Styling tools like straighteners and curling irons are available but the quality is variable. Blow dryers can be found everywhere. . Comfort foods like granola bars, chocolate, trail mix, and coffee (though you will also need to bring a coffee maker as these are difficult to come by) Medications . You should plan to bring the medications that you take daily since the quality of medications abroad may not be the same as in the U.S. . Keep medications in the original prescription bottles and always place them in your carry-on luggage. . Note: some medications that are prescriptions in the U.S. are illegal in other countries. You should check the U.S. Department of State Consular Sheets for Ghana to determine if your medication is allowable. If your medication is not allowed in the country you will be visiting, ask your health-care provider to write a letter on office stationery stating the medication has been prescribed for you. . Many doctors recommend bringing anti-diarrhea medication such as Immodium, ciprofloxacin, and oral rehydration salts to prevent traveler’s diarrhea . Iodine tablets and portable water filters to purify water if bottled water is not available. . Malaria Prophylaxis: Popular forms of prophylaxis are doxycycline and malarone. . Insect repellent with 30-40% DEET as this is NOT readily available in Ghana. Treated and un-treated nets are available in Ghana but it is suggested that you bring your own to bridge you over for the first few days.

Page 9 . Hand sanitizer, though this can be found in larger cities in stores like Melcom or Opoku Trading . Antibacterial wipes for cleaning surfaces . Sun block and mosquito repellent are available in Ghana, although they can be expensive and the quality may be lower than in the U.S. . Sanitary napkins are available in Ghana; tampons are also available but harder to find. If you prefer tampons, bring your own. The quality of the products may be different than what you would obtain in the United States so you may want to pack a box just in case.

Clothes . Since the climate is warm and tropical all year around, be sure to pack light, washable cotton clothing and casual wear. . Rain coat and/or umbrella, especially if you are planning to be in Ghana during the rainy season (from approximately June-November) . Don’t forget your sunglasses and comfortable walking shoes. . There are no restrictions on what men and women may wear – but Ghana is a fairly conservative country. For Western women, it is advisable to be thoughtful with regard to how revealing one’s clothes might be, and opt for longer skirts and modest shirts and blouses (or wraps for the occasional over-air conditioned office). Slacks and shorts for both sexes are permissible, however most locals do not wear shorts. . For individuals who will be working in a clinical setting, it is advisable that you bring your own white laboratory coat and professional attire similar to what you would wear in the U.S. o For men, this means slacks, shirts and ties o For women, this means skirts or professional dresses that hit below the knee or nice trousers. Open-toed shoes can be worn in the hospital but it is recommended that you wear close-toed shoes for your own safety. o For those who will be working in the OR or Emergency Department, you may want to bring your 2-3 sets of scrubs o Do not wear flip flops to work

Page 10 IN-COUNTRY

Communication Internet One of the most efficient ways to stay in touch is to buy a USB modem for your computer that taps into cell phone towers, which means as long as you have money in your account, you can access the internet everywhere. Otherwise, wireless internet is available at upscale hotels and internet cafes.

Be sensitive to the environment you’re in when blogging about your experiences. Make sure you ask for permission to put people’s names in your online journals and note that if you’re writing disparaging remarks about what you see, while you might not get confronted directly, you might have doors close for you or for those who come after you. Assume that what you blog, Facebook, Tweet, etc. will be read by Ghanaians who know you.

Cell phone Cell phones are everywhere! It is best to buy a local cell phone when you arrive. They cost approximately 35 cedis (~$20US) and then you purchase phone cards to add minutes to the phone. Outgoing calls cost money, incoming calls are free.

Etiquette in Ghana suggests that you are expected to answer your cell phone at all times – no convenience screening like in the U.S. Although Ghanaians routinely answer cell phones in the middle of meetings, it is not necessarily polite to answer your phone immediately. Use your best judgment, as you actually might inadvertently insult someone if you answer a call while in a meeting with them.

For keeping in touch with friends and family at home in the U.S., it is possible to buy a U.S. Skype number, and then forward it to your Ghanaian cell phone in Ghana. You will need to have automatic recharge set up on your Skype account to cover the cost (16 cents/min to call Ghana), but then if someone calls your local Skype phone number, your phone in Ghana rings and you pay 16 cents/min. This works for Ghanaian cell phones, where incoming calls are free.

Landline phone Don’t bother. 

Money . Ghana’s currency is the cedi, which comes in denominations of GHC 50, 20, 10, 5 and 1. Coins come in denominations of 1GHC and also 50p, 20p, 10p, 5p and 1 pesewas. Foreign currency can be freely exchanged at any Forex Bureaux in the country.

Page 11 . Some commercial banks also exchange currency and will also have ATMs located outside and available during and after hours. Most will take Visa and a few other check cards. In general, it is not advisable to use an ATM that is not attached to a bank as fraud is quite prevalent in Ghana. . You can use ATMs at hospitals, petrol stations and shopping centers, just make sure it’s not an isolated spot. . All banks and Forex Bureaux accept Traveler’s Checks, although the rate of exchange may be slightly lower than for cash transactions. . The most widely-accepted credit card is Visa, though MasterCard is also accepted at some major hotels, restaurants, banks, supermarkets, and other businesses. Check with your credit/debit card companies for details on merchant acceptability and other services which may be available. Remember to always be cautious when using your credit card in order to avoid fraud. . In general, it is advisable to use only cash, even at major hotels . Tipping is permitted in hotels, restaurants, etc. It is rarely added to the bill. Whenever it is not added, the quality of service should dictate your generosity to the waiter, taxi driver, porter, tour guide, etc.

Transportation & Traveling Many major airlines service Kotoka International Airport in Accra, including United Airlines (via Washington, DC), Delta Airlines (via Atlanta) and KLM (via Amsterdam). Domestically, several airlines provide service between Accra and Kumasi, Tamale, Takoradi and Sunyani, including Antrak Air (www.Antrakair.com) and Citilink (www.flycitylink.com).

Domestically, locals travel via ‘tro tro’ (minivans that, once full, travel given routes) or via bus. Renting a car in Ghana is expensive, as it typically requires paying for petrol, a driver, and his or her meals and accommodations. Taxis are also relatively easy to find. Some ply a certain route and will have a fixed price, and most can be chartered—but negotiate before entering the taxi.

Traveling from Accra to Kumasi takes approximately 4 hours to drive, 6+ hours via bus, or 45 minutes via plane.

Entertainment Upon arrival in Ghana, find a “Time Out Accra” magazine. It will provide a detailed guide to all the local cultural and entertainment happenings in the coming month.

Both Accra and Kumasi have dance clubs, live music, and regular cultural events. The night life in Accra is much more active with major programs happening every weekend, especially at the national theater and the arts center. Kumasi has some night clubs and places like the Bantama high street, where there is a lot of activity over the weekends

Page 12 (at night) and most restaurants are also open in the evening. There are movie theaters in Adum (Rex and Rivoli).

Depending on the period, students on campus (Accra and Kumasi) organize regular weekend entertainment like music shows, movie viewing, etc. It isn’t advised to go out alone at night—campus is generally safer for entertainment purposes, though necessary precautions should still be taken. Information about upcoming entertainment can usually be gotten from friends/social acquaintances and posters on campus.

Food Ghana boasts a wide selection of international restaurants, particularly in Accra downtown “Osu” and Kumasi. Restaurants and fast food outlets provide both international and Ghanaian dishes. Visitors may sample tasty indigenous Ghanaian meals, Indian or Chinese delicacies, as well as continental dishes. Going out to eat costs upwards of 5 cedi; if you don’t plan on cooking, food costs about $150/month.

Adventurous visitors might also want to try dishes served in ubiquitous local “chop bars.” Popular staples include: . Fufu – a pulped, gooey ball of crushed cassava or yam that’s most often served submerged in a light soup . Kenkey and Banku – both are made of fermented maize meal and usually served with tomato-based relish . Jollof Rice – a spicy dish comprised of rice cooked in a tomato sauce with red meat, fish, or chicken . Fried yam sticks (the local equivalent of potato chips), spicy beef kebabs, char- grilled chicken, guinea fowl, and tilapia are all popular bar staples

Health & Safety . One of the best ways to understand the safety of situations is to talk to locals. . It is advisable for visitors to use bottled water which is available for sale in supermarkets or on the street. Bags of water, or “sachets,” are sold on the street, but contamination is a concern and it’s best to boil your water or stick to bottles. . Watch for pickpockets. Taxi cabs and ATMs are the most common sites for crime. Use only secure taxi services. Remember, there is safety in numbers. . Consider purchasing travel insurance with theft insurance for electronics or other valuables. . A money belt is especially nice for traveling long distances. . Contact the U.S. Embassy: http://ghana.usembassy.gov/about_the_embassy.html

Page 13 Housing International dormitories, small guest houses, and shared apartments are available in Kumasi and Accra. In outlying areas, accommodations are likely to be more rustic.

It is always better to make arrangements for housing before arrival. Available places at reasonable prices would be student accommodations in and just outside the university campuses. Booking in advance is helpful because the spaces get filled easily. Expect to pay around $400/ month or 20-80 cedis per night.

Other available accommodations would be guest houses like the Presbyterian Guest House in the heart of the city. Hotel accommodation is widely available but tends to be expensive. It’s usually best to have someone scout for accommodation for you well in advance before arrival to be able to get the best deals. Transportation is widely available to most locations but the further away one is from work, the more traffic one would have to face to and from work.

Local Customs . Greetings are an important social function that mark an open heart and mind. They also express one’s concern for the other. Refusing or failing to greet another person may indicate that you do not care for the other’s welfare. . Greet with good morning, good afternoon and good evening as opposed to hello and hi, unless you’re very familiar with the person . Don’t forget that a smile is also a form of greeting . Handshakes are a popular form of greeting. When you are shaking hands with multiple people, start from the extreme right and proceed towards the left. This is a custom mostly in Kumasi, but most people won’t mind if you’re a foreigner and don’t get it exactly right—as long as you offer your right hand and not your left. . The left hand has limited functions in Ghana. In particular, avoid receiving or giving, gesticulating in speech, waving, or pointing things out with your left hand. If you are naturally left-handed, it is not your fault and it is no offense, but you can avoid embarrassment or complications by holding something (guide book, camera, souvenir, etc.) in your left hand. . Simple vernacular greeting forms include o please – mepaokyew o farewell – bye-bye or o good morning – maakye nantee-yie o good afternoon – maa ha o welcome – akwaaba o good evening – maa-adjo o thank you - medaase o good night – da-yie

Page 14 REFERENCES & RESOURCES

Bartels, P & Herman, E. (2013). King Peggy: An American Secretary, Her Royal Destiny, and the Inspiring Story of How She Changed an African Village. Anchor Group.

Briggs, P. (2014). Ghana: The Bradt Travel Guide (6th ed.). London: Bradt Travel Guides. Updates available at: http://bradtghanaupdate.wordpress.com

Centers for Disease Control and Prevention Travelers’ Health. (n.d.). Retrieved September 14, 2012, from http://wwwnc.cdc.gov/travel/destinations/ghana.htm.

Encyclopedia of the Nations. (n.d.). Retrieved August 21, 2012, from http://www.nationsencyclopedia.com/Africa/Ghana-CLIMATE.html.

Foreign and Commonwealth Office. (August 3, 2012). Retrieved August 21, 2012, from http://www.fco.gov.uk/en/travel-and-living-abroad/travel-advice-by-country/country- profile/sub-saharan-africa/ghana/.

Kunadu Sumprim, Alba (2015). The Imported Ghanaian. Retrieved from http://bradtghanaupdate.wordpress.com

Touring Ghana. (n.d.). Retrieved August 21, 2012, from http://www.touringghana.com/.

Travel.State.Gov. (n.d.). Retrieved August 21, 2012, from http://travel.state.gov/travel/cis_pa_tw/cis/cis_1124.html.

Wikipedia. (September 21, 2012). Retrieved October 1, 2012, from http://en.wikipedia.org/wiki/Health_in_Ghana.

The World Factbook. (September 12, 2012). Retrieved October 1, 2012, from https://www.cia.gov/library/publications/the-world-factbook/geos/gh.html.

World Health Organization. (n.d.). Retrieved October 1, 2012, from http://www.who.int/countries/gha/en/.

We would also like to thank all of the Global Health Fellowship trainees that have contributed to this manual.

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